By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A Cabinet minister last night revealed that incorporating the public clinics into National Health Insurance (NHI) will ensure the scheme’s sustainability by enabling the Government to retain some expenditure.

Dr Michael Darville, minister of health and wellness, told Tribune Business that using the Department of Public Health’s clinics to provide laboratory and diagnostics services to NHI patients will enable them to generate revenue income that will be deposited into the Government’s consolidated fund.

And, instead of being used to cover the Government’s other expenses, he pledged that this revenue will instead be reinvested in upgrading The Bahamas’ public health clinics, expanding NHI and enrolling more Bahamians in the scheme to ensure better healthcare outcomes.

Disclosing that this is “the first time” the public healthcare system is becoming involved with, and integrated into, NHI, Dr Darville told this newspaper the move will ensure the Government-run network is no longer “left behind” and that the scheme is no “skewed” towards private providers.

“For the last three years my ministry has been working very diligently on our digital platform,” he explained. “We will start accepting NHI at our public clinics, and that includes service, diagnostics and laboratory. We will implement laboratory and diagnostic services on every Family Island, and in some additional poly clinics on New Providence.

“The reason that is important is a lot of diagnostics and laboratory services will be handled in the public sector, so that will bring revenue. From that revenue we will be able to bring on more NHI patients. What we’re doing, for the first time since the inception of NHI, is bringing the public clinics on. We’re collecting revenue now.”

Revealing that NHI was never intended to be so dependent on private doctors and other providers to deliver services, Dr Darville added: “It was never supposed to be skewed to the private sector. It was supposed to be both the public and the private sector. For some reason the public sector got left behind.”

Suggesting that this may have been partly due to the public sector clinics falling into “disrepair”, or lacking the necessary healthcare equipment and staff, the minister said: “Now we can fix that. For the first time some of the public clinics will be able to access revenue from NHI.

“The Budget only reflects what we get from the Ministry of Finance. The reality is that when we become revenue-generating some of that money is going to bring more people into NHI, and expand the programme, because some of that money will come back to the Government.

“Now we’re collecting money in the public sector that will be pumped back into the clinics, increasing registration for NHI and expanding the programme. That’s the strategy we have been working on with new laboratory and diagnostic programmes that will reduce waiting time.”

Dr Darville said his ministry was “very close” to completing the digitisation, and creation, of electronic patient medical records. “Digitisation in public health is at an advanced stage, and if all goes well before the end of this year we will be rolling out many digital initiatives,” he added.

Citing improved links with the Public Hospitals Authority’s (PHA) radiology department that will allow “more care” to be provided via the clinics, Dr Darville said: “It’s been a long ride to get the plant in place, all the equipment in place. I have all the digital x-ray equipment in already, and we’re going through the platform for implementation, working to disconnect and replace the analogue e-rays.

He explained that x-ray images could then be sent to the PHA’s radiology department for analysis, with the findings sent back to doctors and patients at the clinic level.

The reform strategy has emerged after it was reported last week that the NHI Authority, which oversees the state-sponsored healthcare initiative that cares for more than 160,000 Bahamians, had again exhausted its Budget allocation and was unable to pay sums owed to physicians and other service providers. Dr Darville yesterday confirmed that those outstanding sums are now being paid.

Christy Butler, the NHI Authority’s managing director and chief executive, in a conciliatory letter acknowledging the impact the scheme’s financial challenges are having on its service providers, attributed the woes to the inability of its “static” $46.2m annual Budget allocation from the Government to keep up with ever-growing patient numbers, its expansion and rising costs.

And she effectively warned providers, and the 160,000 Bahamians cared for under NHI, to brace for potential cut-backs in services and benefits, stating that “additional programme initiatives and efficiencies will be communicated” and discussed before the Government’s new fiscal year starts on July 1.

Mrs Butler, in her letter, sought to place the “delayed provider payments” in the context of the challenges caused by NHI’s growth and its unchanged financing that has failed to keep pace with this.

“Over the last few years, the NHI Authority programme has continued to expand with increased beneficiary enrollment, exponential growth in utilisation, particularly for laboratory services, and increased technology fees to accommodate an evolving programme with a demand for NHI Authority facilities and providers throughout the archipelago,” she wrote.

“Despite the programme’s growth and obvious success, funding has remained static. Additionally, NHI has experienced challenges related to regularised financing, which have made meeting our obligations to providers and vendors increasingly difficult.

“Although there have been previous payment delays, I recognise that this current delay has extended beyond our collective expectations and has put your organisation and operations in uncomfortable positions.”

Mrs Butler pledged that the Authority “is working tirelessly” to resolve the payments situation, but warned that potential restrictions and cost curbs - described as “efficiencies” - are likely to be unveiled and discussed in the coming days. She also urged providers to help it advocate for “proper funding” and timelier payments.

“We have, and will continue, to escalate our requests for adequate and timely funding to meet our obligations and, once received, we will begin processing payments to providers without delay,” she said. “Many of you have inquired about the programme’s future and sustainability. This is an important and relevant question as you plan to participate in the NHI programme.

“As was communicated last year, the NHI Authority Board of Directors approved several programme efficiencies designed to manage resources and improve programme efficiency and value. Additional programme initiatives and efficiencies will be communicated before the new fiscal year begins on July 1, 2025, and further discussed at the upcoming medical director’s meeting.

“These measures are necessary to address the sustainability of the programme.”